Injury to a cardiopulmonary resuscitation provider by sternal wire.

Background: Median sternotomy is a common surgical procedure during cardiac and pulmonary surgeries. There are many reports of patient injury associated with wire breakage. However, there are only a few reports of healthcare worker injuries by sternal wire. Case Presentation: A patient in his 70s, having a history of thoracic aorta replacement, collapsed suddenly and paramedics started mechanical chest compression. On hospital arrival, the emergency department nurse attempted to initiate manual chest compression but was injured by a sternal wire protrusion on the patient's chest. The emergency physician placed gauze on the sternal wire and continued manual chest compression, but the patient died. Conclusion: To prevent this injury, cardiopulmonary resuscitation (CPR) providers should consciously check the patient's chest. If they observe wire exposure, they should immediately place a gauze, pad or consider performing mechanical chest compression. Safety measures such as the installing rubber pads in the AED should be considered.

Effectiveness of Vasopressin Against Cardiac Arrest: A Systematic Review of Systematic Reviews.

PURPOSE: This systematic review (SR) of SRs evaluates the effectiveness of vasopressin alone or in combination with other drugs in improving the outcomes of cardiac arrest (CA). METHODS: Using a three-step approach, we searched five databases to identify all relevant SRs. Two reviewers independently selected suitable studies, assessed study quality, and extracted relevant data. If an outcome was reported by multiple SRs, a re-meta-analysis was conducted as needed; otherwise, a narrative analysis was performed. RESULTS: Twelve SRs covering 16 original studies were included in this review. The meta-analysis results revealed a significant increase in survival to hospital admission for patients with in-hospital CA (IHCA) or out-of-hospital CA (OHCA) receiving vasopressin alone compared with that for those receiving epinephrine alone. Furthermore, the return of spontaneous circulation (ROSC) was significantly increased in patients with OHCA receiving vasopressin with epinephrine compared with that in those receiving epinephrine alone. Compared with patients with IHCA receiving epinephrine with placebo, those receiving vasopressin, steroids, and epinephrine (VSE) exhibited significant increases in ROSC, survival to hospital discharge, favorable neurological outcomes, mean arterial pressure, renal failure-free days, coagulation failure-free days, and insulin requirement. CONCLUSION: VSE is the most effective drug combination for improving the short- and long-term outcomes of IHCA. It is recommended to use VSE in patients with IHCA. Future studies should investigate the effectiveness of VSE against OHCA and CA of various etiologies, the types and standard dosages of steroids for cardiac resuscitation, and the effectiveness of vasopressin-steroid in improving CA outcomes.

Abdominal compressions during cardiopulmonary resuscitation: a scoping review / Compresiones abdominales durante la reanimación cardiopulmonar: una revisión de alcance / Compressões abdominais durante a reanimação cardiopulmonar: revisão de escopo

ABSTRACT Objectives: to map the scientific evidence on the use of abdominal compressions during cardiopulmonary resuscitation in patients with cardiac arrest. Methods: this is a scoping review based on the question: "What is the evidence regarding the use of abdominal compressions during cardiopulmonary resuscitation in patients with cardiac arrest?". Publications up to August 2022 were collected from eight databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was used. Results: seventeen publications were included. The identified general population consisted of adults and elderly individuals. The primary outcome revealed significant rates of return of spontaneous circulation. Secondary outcomes indicated a significant improvement in heart rate, blood pressure, oxygen saturation, and other outcomes. Conclusions: abdominal compressions have been shown to be beneficial. However, further clinical studies are needed to identify the best execution method and its impacts.

RESUMEN Objetivos: mapear la evidencia científica sobre el uso de compresiones abdominales durante la reanimación cardiopulmonar en pacientes con paro cardíaco. Métodos: esta es una revisión de alcance basada en la pregunta: "¿Cuál es la evidencia con respecto al uso de compresiones abdominales durante la reanimación cardiopulmonar en pacientes con paro cardíaco?". Se recopilaron publicaciones hasta agosto de 2022 de ocho bases de datos. Se utilizó la extensión de Informes Preferidos para Revisiones Sistemáticas y Metaanálisis para Revisiones de Alcance. Resultados: se incluyeron diecisiete publicaciones. La población general identificada estaba compuesta por adultos y personas mayores. El resultado primario reveló tasas significativas de retorno de la circulación espontánea. Los resultados secundarios indicaron una mejora significativa en la frecuencia cardíaca, la presión arterial, la saturación de oxígeno y otros resultados. Conclusiones: las compresiones abdominales han demostrado ser beneficiosas. Sin embargo, se necesitan más estudios clínicos para identificar el mejor método de ejecución y sus impactos.

RESUMO Objetivos: mapear as evidências científicas sobre o uso de compressões abdominais durante a reanimação cardiopulmonar em pacientes com parada cardiorrespiratória. Métodos: trata-se de uma revisão de escopo, baseada na questão: "quais são as evidências sobre o uso de compressões abdominais durante a reanimação cardiopulmonar em pacientes com parada cardiorrespiratória?". Foram coletadas as publicações até agosto de 2022 em oito bases de dados. Foi utilizado o Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Resultados: incluiu-se 17 publicações. O público geral identificado foi composto por adultos e idosos. O desfecho primário evidenciou taxas significativas de retorno da circulação espontânea. Os desfechos secundários indicaram melhora significativa na frequência cardíaca, pressão arterial, saturação de oxigênio e outros resultados. Conclusões: as compressões abdominais mostraram-se benéficas. No entanto, mais estudos clínicos são necessários para identificar o melhor método de execução e seus impactos.

Advanced and Invasive Cardiopulmonary Resuscitation (CPR) Techniques as an Adjunct to Advanced Cardiac Life Support.

BACKGROUND: Despite numerous promising innovations, the chance of survival from sudden cardiac arrest has remained virtually unchanged for decades. Recently, technological advances have been made, user-friendly portable devices have been developed, and advanced invasive procedures have been described that could improve this unsatisfactory situation. METHODS: A selective literature search in the core databases with a focus on randomized controlled trials and guidelines. RESULTS: Technical aids, such as feedback systems or automated mechanical cardiopulmonary resuscitation (CPR) devices, can improve chest compression quality. The latter, as well as extracorporeal CPR, might serve as a bridge to treatment (with extracorporeal CPR even as a bridge to recovery). Sonography may be used to improve thoracic compressions on the one hand and to rule out potentially reversible causes of cardiac arrest on the other. Resuscitative endovascular balloon occlusion of the aorta might enhance myocardial and cerebral perfusion. Minithoracostomy, pericardiocentesis, or clamshell thoracotomy might resolve reversible causes of cardiac arrest. CONCLUSIONS: It is crucial to identify those patients who may benefit from an advanced or invasive procedure and make the decision to implement the intervention in a timely manner. As with all infrequently performed procedures, sound education and regular training are paramount.

Development and Validation of a Novel Ultra-Compact and Cost-Effective Device for Basic Hands-On CPR Training: A Randomized, Sham-Controlled, Blinded Trial.

To examine the performance of a novel low-cost, ultra-compact, and attractive auditory feedback device for training laypeople in external chest compressions (ECCs), we conducted a quasi-experimental cross-sectional study from September to November 2021 at the Faculty of Nursing of Albacete, University of Castille-La Mancha, Spain. The ECC sequence was performed in the laboratory with the new device for basic hands-on CPR training. Results: One hundred college students were included in this study. The compression rate/min with the new device was 97.6, and the adequate %ECC was 52.4. According to the status of body mass index (BMI) and muscle strength of the upper limbs in the bivariate analysis, it was observed that the new device discriminated between those who performed correct ECCs according to their BMI and muscle strength and those who did not, which led to significantly influenced results in terms of the percentage of ECCs with correct depth. Conclusions: The new ultra-compact auditory feedback device "Salvando a Llanetes®" demonstrated utility for teaching and learning ECCs in basic CPR. We can affirm that the analyzed device is an adequate, safe and economical method for teaching "CPR Hands-Only™" to the general population.

Rescuers' characteristics associated with the correct chest compression during cardiopulmonary resuscitation.

AIM: To analyse the caregivers' physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR). METHODS: An observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models. RESULTS: Two hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR = 3.03; 95% CI 1.2-7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI .87-.99) and grip strength (OR: .94; 95% CI .89-.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil. CONCLUSIONS: The caregiver's previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional's height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.

Características de los reanimadores asociadas a la correcta compresión torácica durante la reanimación cardiopulmonar / Rescuers’ characteristics associated with the correct chest compression during cardiopulmonary resuscitation

Objetivos: Analizar las características físicas, antropométricas y formativas de los reanimadores asociadas a la correcta compresión y reexpansión torácica durante la reanimación cardiopulmonar. Metodología: Estudio observacional prospectivo. Profesionales y estudiantes sanitarios de urgencias y cuidados críticos realizaron 2min de compresiones torácicas sobre un maniquí. Se evaluó la profundidad y la presión residual tras las compresiones, y se estudió su asociación a diferentes variables (físicas, antropométricas y formativas) mediante la creación de modelos de regresión logística. Resultados: Participaron 238 voluntarios. Que el reanimador tuviese una experiencia previa en menos de 6 reanimaciones cardiopulmonares (OR: 3,03; IC 95%: 1,2-7,63) se asoció a una mayor probabilidad de no lograr una profundidad adecuada en las compresiones. Una mayor estatura (OR: 0,93; IC 95%: 0,87-0,99) y fuerza de aprehensión (OR: 0,94; IC 95%: 0,89-0,99) fueron condiciones que actuaron como factores predisponentes a la ejecución de una técnica correcta. Ninguna característica se asoció a la adecuación de la reexpansión torácica. Conclusiones: La experiencia previa del reanimador es el factor más fuertemente asociado a la correcta ejecución de las compresiones torácicas. En menor medida, también influye la estatura y la fuerza del tren superior del profesional. No se han identificado factores asociados a la adecuación de la reexpansión torácica tras las compresiones.(AU)

Aim: To analyse the caregivers’ physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR). Methods: An observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models. Results: Two hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR: 3.03; CI 95%: 1.2-7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI: .87-.99) and grip strength (OR: .94; 95% CI: .89-.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil. Conclusions: The caregiver's previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional's height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.(AU)

Rescuers' characteristics associated with the correct chest compression during cardiopulmonary resuscitation. / Características de los reanimadores asociadas a la correcta compresión torácica durante la reanimación cardiopulmonar.

AIM: To analyse the caregivers' physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR). METHODS: An observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models. RESULTS: Two hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR: 3.03; CI 95%: 1.2-7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI: .87-.99) and grip strength (OR: .94; 95% CI: .89-.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil. CONCLUSIONS: The caregiver's previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional's height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.

Straddle versus Conventional Chest Compressions in a Confined Space; a Comparative Study.

INTRODUCTION: When cardiac arrest occurs in a confined space, such as in an aircraft or ambulance, kneeling by the patient's side may be difficult. Straddle chest compression is an alternative technique that can be used in a confined space. This study was performed to compare the quality of chest compressions in straddle versus conventional CPR on a manikin model. METHODS: The participants were randomized into two groups using the sequential numbered, opaque, sealed envelope method chosen through block-of-four randomization: straddle and conventional chest compression technique. Each participant performed a maximum of 4 minutes of hands-only chest compressions, and quality parameters (compression rate and depth) were recorded from the defibrillator's monitor. RESULTS: 124 participants with mean age of 26.67 ± 6.90 years (27.58% male) were studied. There was no difference in the mean compression rate between the conventional and straddle chest compression techniques (126.18 ± 17.11 and 127.01 ± 21.01 compressions/min, respectively; p = 0.811) or their mean compression depth (43.8 ± 9.60 and 43.4 ± 9.10 mm, respectively; p = 0.830). The participants' comfort and fatigue were assessed through changes in their vital signs. In both methods, statistically significant differences were observed in vital signs before and after performing chest compression, but the differences were not clinically significant. In addition, there was no difference between the 2 groups in this regard. CONCLUSION: The quality of CPR using the straddle chest compression was as good as conventional chest compression technique. No significant differences were found in the quality of chest compressions or the participants' comfort and fatigue levels.

Parada cardiorrespiratória na pandemia por coronavírus: revisão compreensiva da literatura / Cardiorespiratory arrest in a coronavirus pandemic: comprehensive literature review / Paro cardiorrespiratorio en una pandemia de coronavirus: revisión exhaustiva de la literatura

Objetivo: apresentar atualizações para a ressuscitação cardiopulmonar em pacientes suspeitos e confirmados com COVID-19. Método: revisão compreensiva da literatura, com síntese narrativa das evidências de diretrizes e recomendações da Organização Mundial de Saúde, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma e National Association of Emergency Medical Technicians. Resultados: as principais atualizações trazem informações sobre especificidades das manobras de ressuscitação cardiopulmonar; preparação do ambiente, recursos humanos e materiais, reconhecimento da parada cardiorrespiratória e ações iniciais; estratégias de ventilação e acesso invasivo da via aérea; ajustes do ventilador mecânico e manobras de ressuscitação cardiopulmonar em pacientes pronados. Considerações finais: profissionais de saúde envolvidos no atendimento à parada cardiorrespiratória de pacientes suspeitos e/ou confirmados com COVID-19 podem encontrar inúmeros desafios, portanto devem seguir com rigor o protocolo estabelecido para maximizar a efetividade das manobras de ressuscitação e minimizar o risco de contágio pelo vírus e sua disseminação.

Objective: to present updates for cardiopulmonary resuscitation in suspected and confirmed patients with COVID-19. Method: comprehensive literature review with narrative synthesis of the evidence of guidelines and recommendations from World Health Organization, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Results: the main updates bring information about the specifics of cardiopulmonary resuscitation maneuvers; preparation of the environment and human and material resources, recognition of cardiorespiratory arrest and initial actions; ventilation and invasive airway access strategies; mechanical ventilator adjustments and cardiopulmonary resuscitation maneuvers in patients in the prone position. Final considerations: health professionals involved in the care of cardiorespiratory arrest of suspected and/or confirmed patients with COVID-19 can face numerous challenges, so they must strictly follow the protocol established to maximize the effectiveness of resuscitation maneuvers and minimize the risk of contagion by the virus and its spread.

Objetivo: apresentar actualizaciones para la reanimación cardiopulmonar en pacientes sospechos os y confirmados con COVID-19. Método: revisión exhaustiva de la literatura con síntesis narrativa de la evidencia de guías y recomendaciones de la Organización Mundial de la Salud, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Resultados: las principales actualizaciones aportan información sobre los detalles de las maniobras de reanimación cardiopulmonar; preparación del medio ambiente y recursos humanos y materiales, reconocimiento de paro cardiorrespiratorio y acciones iniciales; estrategias de ventilación y acceso invasivo a las vías aéreas; ajustes del ventilador mecánico y maniobras de reanimación cardiopulmonar en pacientes en decúbito prono. Consideraciones finales: los profesionales de la salud involucrados en la atención del paro cardiorrespiratorio de pacientes sospechosos y/o confirmados con COVID-19 pueden enfrentar numerosos desafíos, por lo que deben seguir estrictamente el protocolo establecido para maximizar la efectividad de las maniobras de reanimación y minimizar el riesgo de contagio por el virus y supropagación.

Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.

Effects of Chest Compression Fraction on Return of Spontaneous Circulation in Patients with Cardiac Arrest; a Brief Report.

INTRODUCTION: The association between chest compression fraction (CCF) and return of spontaneous circulation (ROSC)has been a controversial issue in literature; and both positive and negative correlations have been reported between CCF and survival rate. OBJECTIVE: The present study was conducted to determine the relationship between the rate and outcomes of chest compression and between CCF and ROSC in patients with cardiac arrest. METHOD: The present prospective observational study was conducted during 2018 on patients with cardiac arrest aged 18-80 years. Participants with end-stage renal diseases, malignancies and grade IV heart failure were excluded. A stop watch was set upon the occurrence of a code blue in the emergency department, and time was recorded by the observer upon the arrival of the code blue team leader (a maximum permissible duration of 10 minutes). The interruptions in chest compressions were recorded using a stopwatch, and CCF was calculated by dividing the duration of chest compression by the total duration of cardiac arrest observed. RESULTS: Totally, 45 participants were enrolled. Most of the patients had non-shockable rhythms and underwent CPR based on related algorithm. Hypoxia and hypovolemia were the two probable etiology of cardiac arrest; and coronary artery disease was the most prevalent underlying disease. All patients with ROSC had CCF more than 70%. A CCF below 70% was observed in 21 cases (46.7%), and a fraction of at least 70% in 24 cases. All patients with ROSC had CCF more than 70%. A CCF below 70% was observed in 21 cases (46.7%), and a fraction of at least 70% in 24. A significantly higher duration and fraction of chest compression was observed in the participants who attained ROSC (P<0.001). CONCLUSION: Based on the findings of current study, it seems that significantly higher chest compression durations and fractions were found to be associated with ROSC, which was achieved in the majority of the participants with a CCF of at least 80%.

Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study.

BACKGROUND: Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial ventilation using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient's side with compression conducted from the 'over-the-head' position. METHODS: The subject of the study were two methods of CPR - 'standard' (STD) and 'over-the-head' (OTH). The STD method consisted of cycles of 30 chest compressions from the patient's side, and two attempts at artificial ventilation after moving round to behind the patient's head. In the OTH method, both compressions and ventilations were conducted from behind the patient's head. RESULTS: Both CPR methods were conducted by 38 paramedics working in medical response teams. Statistical analysis was conducted on the data collected, giving the following results: the average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p < 0.001); the depth of compression 50-60 mm (STD 50.65%, OTH 60.22%, p < 0.001); the rate of compression 100-120/min. (STD 46.39%, OTH 53.78%, p < 0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p < 0.001); correct hand position (STD 99.32%, OTH method 99.66%, p < 0.001). A statistically significant difference was demonstrated in the results to the benefit of the OTH method in the above parameters. The remaining parameters showed no significant differences in comparison to reference values. CONCLUSIONS: The higher quality of CPR in the simulated research using the OTH method by a single person justifies the use of this method in a wider range of emergency interventions.

Effect of Watch-Type Haptic Metronome on the Quality of Cardiopulmonary Resuscitation: A Simulation Study.

OBJECTIVES: The aim of this study was to test the applicability of haptic feedback using a smartwatch to the delivery of cardiac compression (CC) by professional healthcare providers. METHODS: A prospective, randomized, controlled, case-crossover, standardized simulation study of 20 medical professionals was conducted. The participants were randomly assigned into haptic-first and non-haptic-first groups. The primary outcome was an adequate rate of 100-120/min of CC. The secondary outcome was a comparison of CC rate and adequate duration between the good and bad performance groups. RESULTS: The mean interval between CCs and the number of haptic and non-haptic feedback-assisted CCs with an adequate duration were insignificant. In the subgroup analysis, both the good and bad performance groups showed a significant difference in the mean CC interval between the haptic and non-haptic feedback-assisted CC groups-good: haptic feedback-assisted (0.57-0.06) vs. non-haptic feedback-assisted (0.54-0.03), p < 0.001; bad: haptic feedback-assisted (0.57-0.07) vs. non-haptic feedback-assisted (0.58-0.18), p = 0.005-and the adequate chest compression number showed significant differences- good: haptic feedback-assisted (1,597/75.1%) vs. non-haptic feedback-assisted (1,951/92.2%), p < 0.001; bad: haptic feedbackassisted (1,341/63.5%) vs. non-haptic feedback-assisted (523/25.4%), p < 0.001. CONCLUSIONS: A smartwatch cardiopulmonary resuscitation feedback system could not improve rescuers' CC rate. According to our subgroup analysis, participants might be aided by the device to increase the percentage of adequate compressions after one minute.

Two new chest compression methods might challenge the standard in a simulated infant model.

Paediatric cardiorespiratory arrest is a rare event that requires a fast, quality intervention. High-quality chest compressions are an essential prognostic factor. The aim of this prospective, randomized and crossover study in infant manikin 2-min cardiorespiratory resuscitation scenario is to quantitatively compare the quality of the currently recommended method in infants (two-thumb-encircling hand techniques) with two new methods (the new two-thumb and the knocking-fingers techniques) using a 15:2 compression-to-ventilation ratio. Ten qualified health professionals were recruited. Variables analysed were mean rate and the ratio of compressions in the recommended rate range, mean depth and the ratio of compressions within the depth range recommendations, ratio of compressions with adequate chest release and ratio of compressions performed with the fingers in the correct position. Ratios of correct compressions for depth, rate, chest release and hand position were always above 70% regardless of the technique used. Reached mean depth and mean rate were similar to the 3 techniques. No statistically significant differences were found in any of the variables analysed.Conclusion: In an infant manikin, professionals are able to perform chest compressions with the new techniques with similar quality to that obtained with the standard method. What is Known: • Quality chest compressions are an essential prognostic factor in paediatric cardiorespiratory arrest. • It has been reported poor results when studied cardiorespiratory resuscitation quality in infants applying the recommended methods. What is New: • In a simulated scenario, quality of chest compressions performed with two new techniques (nTTT and KF) is similar to that obtained with the currently recommended method (TTHT).

Cardiac massage for trauma patients in the battlefield: An assessment for survivors.

INTRODUCTION: Survival from traumatic cardiopulmonary arrest (TCA) has been reported at a rate as low as 0-2.6% in the civilian pre-hospital setting, and many consider resuscitation of this group to be futile. The aim of this investigation was to describe patients who received cardiac massage during TCA in a battlefield setting; we also aimed to identify predictors of survival. METHODS: We conducted a review of the Department of Defense Trauma Registry to identify patients who received cardiac massage in the battlefield between 2007 and 2014. Patients were also grouped according to location of cardiac arrest: pre-hospital (PH) and in-hospital (IH). The groups were compared and evaluated by injury, transport time, type of resuscitation, and pre-hospital procedures. Outcome variables included survival to discharge and 30-day survival. Categorical variables were analysed using chi-square or Fisher's exact tests. Wilcoxon tests were performed for continuous variables. Regression modelling was used to assess for predictors of survival. RESULTS: 75 of all 582 patients (13%, 95% CI 10-16) survived to 30 days, and all survivors were transported out of the battlefield; 23 PH (7.8%, 95% CI 5.2-12) and 52 IH (17%, 95% CI 13-22) patients survived to 30 days (p < 0.001). Closed-chest cardiac massage with the administration of intravenous medications was associated with 30-day survival among IH patients. CONCLUSIONS: We report a 13% survival to 30 days among all patients receiving cardiac massage in a battlefield setting. Closed-chest cardiac massage predicted survival among IH TCA victims who also received intravenous medications in this review of combat-related TCA.

A new chest compression technique in infants. / Nueva técnica de masaje cardíaco en lactantes.

OBJECTIVE: To compare the quality of chest compressions performed according to the classical technique (MT) versus a new technique (NM) (compression with 2thumbs with closed fists) in an infant manikin. DESIGN: A controlled, randomized cross-over study was carried out in professionals assisting pediatric patients. SETTING: A University Hospital with a Pediatric ICU in the north of Spain. PARTICIPANTS: Residents and nurses in Pediatrics who had completed a basic and an advanced pediatric cardiopulmonary resuscitation course. INTERVENTIONS: Quantitative analysis of the variables referred to chest compression quality in a 2-minute cardiopulmonary resuscitation scenario in infants. Laerdal's SimPad® with SkillReporter™ system was used. MAIN VARIABLES OF INTEREST: Mean rate and percentage of compressions in the recommended rate range, mean depth and percentage of compressions within the depth range of recommendations, percentage of compressions with adequate decompression, and percentage of compressions performed with the fingers in the center of the chest. RESULTS: Global quality of the compressions (NM: 84.2±23.7% vs. MT: 80.1±25.4% [p=0.25; p=ns]), percentage of compressions with correct depth (NM: 59.9±35.8% vs. MT: 59.5±35.7% [p=0.76; p=ns]), mean depth reached (NM: 37.3±3.8mm vs. MT: 36±5.3mm [p=0.06; p=ns]), percentage of complete re-expansion of the chest (NM: 94.4±9.3% vs. MT: 92.4±18.3% [p=0.58; p=ns]), and percentage of compressions with the recommended rate (NM: 62.2±34.6% vs. MT: 51±37.2% [p=0.13; p=ns]) proved similar with both methods. CONCLUSIONS: The quality of chest compressions with the new method (thumbs with closed fists) is similar to that afforded by the traditional method.

Effect of Watch-Type Haptic Metronome on the Quality of Cardiopulmonary Resuscitation: A Simulation Study / 대한의료정보학회지

OBJECTIVES: The aim of this study was to test the applicability of haptic feedback using a smartwatch to the delivery of cardiac compression (CC) by professional healthcare providers. METHODS: A prospective, randomized, controlled, case-crossover, standardized simulation study of 20 medical professionals was conducted. The participants were randomly assigned into haptic-first and non-haptic-first groups. The primary outcome was an adequate rate of 100–120/min of CC. The secondary outcome was a comparison of CC rate and adequate duration between the good and bad performance groups. RESULTS: The mean interval between CCs and the number of haptic and non-haptic feedback-assisted CCs with an adequate duration were insignificant. In the subgroup analysis, both the good and bad performance groups showed a significant difference in the mean CC interval between the haptic and non-haptic feedback-assisted CC groups—good: haptic feedback-assisted (0.57–0.06) vs. non-haptic feedback-assisted (0.54–0.03), p < 0.001; bad: haptic feedback-assisted (0.57–0.07) vs. non-haptic feedback-assisted (0.58–0.18), p = 0.005—and the adequate chest compression number showed significant differences— good: haptic feedback-assisted (1,597/75.1%) vs. non-haptic feedback-assisted (1,951/92.2%), p < 0.001; bad: haptic feedbackassisted (1,341/63.5%) vs. non-haptic feedback-assisted (523/25.4%), p < 0.001. CONCLUSIONS: A smartwatch cardiopulmonary resuscitation feedback system could not improve rescuers' CC rate. According to our subgroup analysis, participants might be aided by the device to increase the percentage of adequate compressions after one minute.

Cardiopulmonary Resuscitation Quality Issues.

Much of the current evidence and many of the recent treatment recommendations for increasing survival from cardiac arrest revolve around improving the quality of cardiopulmonary resuscitation during resuscitation. A focus on providing treatments proved beneficial and providing these treatments reliably, using measurement, monitoring, and implementation of quality-improvement strategies, will help eliminate variation in outcomes and provide a foundation from which future improvements in resuscitation care can be developed. Using the knowledge and tools available today will help reduce the ambiguity and variability that exists in resuscitation today and provide the ability to save more lives in communities.

2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

This focused update to the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care follows the Pediatric Task Force of the International Liaison Committee on Resuscitation evidence review. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, and updates are published when the International Liaison Committee on Resuscitation completes a literature review based on new science. This update provides the evidence review and treatment recommendation for chest compression-only CPR versus CPR using chest compressions with rescue breaths for children <18 years of age. Four large database studies were available for review, including 2 published after the "2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Two demonstrated worse 30-day outcomes with chest compression-only CPR for children 1 through 18 years of age, whereas 2 studies documented no difference between chest compression-only CPR and CPR using chest compressions with rescue breaths. When the results were analyzed for infants <1 year of age, CPR using chest compressions with rescue breaths was better than no CPR but was no different from chest compression-only CPR in 1 study, whereas another study observed no differences among chest compression-only CPR, CPR using chest compressions with rescue breaths, and no CPR. CPR using chest compressions with rescue breaths should be provided for infants and children in cardiac arrest. If bystanders are unwilling or unable to deliver rescue breaths, we recommend that rescuers provide chest compressions for infants and children.